This is a competingrenewalapplicationfor the EasternMassachusettsPreventionEpicenter,whichincludes 16 health care institutionst:hestate'stwo largesthealthplans,caringfor over halfthe state'spopulation;six adultacademic referralcenters;a cancer hospital;a pediatricacademic healthcenter;five community hospitals;and a rehabilitationfacility.The Epicenterwill pursuefouraims that buildon itswork of the past eightyears. These includedevelopingsurrogatemarkersfor surveillanceof healthcare-associatedinfections andotheradverseevents,and assessmentand preventionof antimicrobialresistance.We will 1) Test a claims-basedalgorithmwe developedfor identifyinghospitalswith highratesof surgicalsiteinfection(SSI) follm,ing,,c,o_ronary artery bypassgrafting(CABG). We willworkwith the Centerfor Medicareand Medicaid Services(CMS) andthe OklahomaQIO SupportCenter toevaluate>800 hospitalsand >200,000 CABG }rocedures.If successful,this approachwill allow efficientand uniformassessmentof essentiallyall losp_talsperformingthis procedure,permittingefficienttargetingof quality improvementactivities.It willalso setthe stage for claimsbased SSI surveillancefor otherprocedures.2) Developsurrogatemeasuresto supportinpatientsurveillancefor SSI followingtheSurgicalCare ImprovementProject(SCIP) procedures. This aim extendsour longstandingwork showingtheutilityof quantitativeantibioticexposureas a marker for SS!foIlo;,,'ingCABG, breastsurgery,and cesareandelivery.3) Evaluatethe abilityof automatedstanding ordersin an electronicorderentrysystemtosustainstaffcompliancewitha successfulMRSA prevention program.This work buildson a demonstrationprogramthatwas effectivebutdependedon dailyhighlevel infectioncontrol clinicianparticipation4. ) Assess the utilityof administrativeclaimsdatato identifyadditional adverseevents, includingnon-infectiouscomplicationsof surgery.We willespeciallyemphasize identificationof post-dischargemorbidity.These eventswill includemyocardialinfarction,deepvein thrombosis,and C. difficileassociateddisease. We willfocusonproceduresand outcomesthat are part of the currentNational SurgicalQualityImprovementProgramand SCIP initiatives.We will performeconomic analysesfor all of these programs.The Epicenterwillcontinueparticipatingin multi-Epicenterinitiatives,and it willcontinueto respondtoCDC's interestsandneeds inaddressingnew problems. _R.U.A.NCE S/TE(S) (ce'_."_aSon. dry. state) Beth Israel Deaconess MedicalCenter (BIDMC), Boston,MA BlueCrossrBlueShield of Massachusetts(BCBS/MA),Boston,MA BostonMedicalCenter (BMC),Boston,MA Brigham&Women's Hospital(BWH), Boston,MA Centerfor Medicare and MedicaidServices (CMS), Baltimore,MD Children'sHospital, Boston(CHB), MA Dana Farber Caner Institute,Boston(DFCI), MA FaulknerHospital, Boston,MA HarvardMedical School(HMS) Departmentof AmbulatoryCare andPrevention(DACP), Boston,MA HarvardPilgrim Healthcare (HPHC), Boston,MA LaheyClinic, Burlington,MA Massachusetts General Hospital (MGH), Boston, MA NewEngland Medical Center (NEMC), Boston, MA Newton-Wellesley Hospital, Newton, MA Salem Hospital, Salem, I%_k Spaulding Rehabilitation Hospital, Boston, MA Oklahoma Foundation for Medical Quality (QIOSC), Oklahoma City, OK Union Hospital, Lynn, MA PH3 3_3 (Rev. 0c.'04) Page 2 Form Page 2 Pf.'-_pal I,_o'es_gatodPr_jramDirector(last, First,Middle): Platt, Richard PER.SO.N;;=_LSee L"_._(_LS. Use continuab'onpages as needed to provide the requiredinformation in the format shown below. S.'_..v'I,_ P_n_] I?,'es_gaL,_'.List a_lother key personnel in alphabetical order, last name first. t_.,_e eRA CommonsUser Name Organization Role on Project Plait, Richard, MD, MS HPHC, BWH, HMS PrincipalInvestigator Huang,Susan, MD, MPH BWH Co-investigator Kleinman,Ken, ScD HPHC, HMS Co-investigator Prosser, Usa, PhD HPHC, HMS Co-investigator Yokoe, Deborah, MD, MPH BWH, DFCI Co-investigator OTH=.=.S=I.G=.='_.=R.C=.A=.N=_TRCO,NTPJBUTORS l_'_.me Organization Role on Project Bratzler, Dale, DO, MPH QIOSC Collaborator Gustafson, Michael, MD, MBA BWH, Faulkner Collaborator Hunt, David, MD, FCAS CMS Collaborator Rogers, Sek'6n'l,MD, MPH BWH Collaborator Human Embryonic Stem Cells [] No [] Yes If L--_e-c-pcsedpcojectInvolveshuman embryonicstem cells,list below the reglsb'atJonumberof thespecificcellline(s) fromthe followinglist: h_:h'stemcetls.nih.oov/'reaistry/index.asD. Use [unreadable]onb'nuationpages asneeded. ffa soec_[unreadable]L'-Je[unreadable]m.-v'xb_erefere,,x:_,adt thistSmei.ncludea statementhatonefromtheRegistryvailbe used. CellUne Disclosure Pe.'Tnission StatemenL App_cabTeto SBIFUS'I-rROnly. See SBIR/STTR instructions. [] Yes [] No PHS 3._3(Re./. 0_'04) Page3 Form Page 2-continued NumbetrhefoflowingpagesconsecuSvethlyroughout theappScatJoDno.notusesuffixesuchas4a,4b. Pf.-._pal I.,_'es'C_atcr,'Prog,"aDmirector(Last,First, MiddIe): Platt, Richard The r.a..'n.cef L_,ep,_,'_dpaLlw, es'C_jatorlprogramdirector must be provided at the top of each printed page and eachcontinuation page. RESEARCH GRANT TABLE OF CONTENTS Page Numbers Face Page................................................................................................................................................. 1 Description,